Prior Authorization Specialist

BrightSpring Health Services; Louisville (KY); On-site; USD 24,796 - 35,817; Full time

Benefits offered by this job

DailyPay

Flexible schedules

Competitive pay

Shift differential

Health insurance

Dental insurance

Vision insurance

Life insurance

STD & LTD paid by company

Tuition Assistance

Employee Discount Program

401k

Paid-time off

Tuition reimbursement

Non-retail/Closed-door environment

Job summary

PharMerica in Louisville is seeking a Prior Authorization Coordinator to focus on completing approvals for pharmacy claims or coordinating with prescribers to switch therapy when insurance does not cover the treatment.

The role requires strong customer service and communication skills, attention to deadlines, and proficiency with Word/Excel. Day-to-day duties include claims tracking, collaboration with billing, and supporting pharmacy operations.

Qualifications

• High School Diploma or GED required.
• Kentucky Pharmacy Technician License preferred.
• Excellent customer service and communication skills.
• Ability to prioritize and meet deadlines.
• Proficient typing and advanced computer skills.
• Experience in healthcare billing environment (pharmacy preferred).
• Familiarization with on-line claims processing and Medicaid and Medicare billing practices.
• Proficient with Microsoft Word & Excel.

Responsibilities

• Ensure accurate and timely completion of client prior authorization and/or change of therapy paperwork by collaborating with prescribers and facility contacts.
• Follows up on all claims requiring prior authorization within four to five business days.
• Tracks and reviews all claims in QuickBase and sends excel tracking spreadsheet to Director of Pharmacy on weekly basis.
• Compares system report of unbilled claims requiring prior approval to QuickBase tracking system to ensure any claim requiring prior authorization is being followed up on.
• Assists Billing Department with resolving unbilled claims at each month end close.
• Advocates for clients as needed.
• Support for Pharmacy Operations.
• Adjudicates and resolution of claim rejections as needed.
• Utilizes Frameworks, QuickBase, Docutrack, and CoverMyMeds in order to complete workflow on daily basis.
• Other responsibilities as assigned.

Skills

Customer service

Communication skills

Multitasking

Typing proficiency

Education

High School Diploma/GED

Kentucky Pharmacy Technician License

Tools

Microsoft Word

Microsoft Excel

Job description

Overview

Join our PharMerica team! PharMerica is a closed-door pharmacy where you can focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacy environment. Our organization is in high growth mode, which means advancement opportunities for individuals who are looking for career progression!

Mon-Fri (8:30am to 5pm)

Benefits

• DailyPay
• Flexible schedules
• Competitive pay
• Shift differential
• Health, dental, vision and life insurance benefits
• Company paid STD and LTD
• Tuition Assistance
• Employee Discount Program
• 401k
• Paid-time off
• Tuition reimbursement
• Non-retail/Closed-door environment

Responsibilities

• The Prior Authorization Coordinator is responsible for striving to complete either approval for pharmacy claims requiring prior authorization or by coordinating with prescribers and or facility contact to have therapy changed to a preferred alternative due to insurance not covering the treatment in question

Essential Job Responsibilities:

• Ensure accurate and timely completion of client prior authorization and/or change of therapy paperwork by collaborating with prescribers and facility contacts
• Follows up on all claims requiring prior authorization within four to five business days
• Tracks and reviews all claims in QuickBase and sends excel tracking spreadsheet to Director of Pharmacy on weekly basis
• Compares system report of unbilled claims requiring prior approval to QuickBase tracking system to ensure any claim requiring prior authorization is being followed up on
• Assists Billing Department with resolving unbilled claims at each month end close
• Advocates for clients as needed
• Support for Pharmacy Operations
• Adjudicates and resolution of claim rejections as needed
• Utilizes Frameworks, QuickBase, Docutrack, and CoverMyMeds in order to complete workflow on daily basis
• Other responsibilities as assigned

Qualifications

• High School Diploma/General Education Diploma required
• Kentucky Pharmacy Technician License preferred
• Excellent customer service and communication skills, both written and verbal
• Ability to prioritize and meet pre-determined deadlines
• Must be able to effectively multi-task, be proficient at typing, and have advanced technical skills
• Experience in healthcare billing environment (pharmacy preferred)
• Familiarization with on-line claims processing and Medicaid and Medicare billing practices
• Proficient with Microsoft Word & Excel required